OP 98. Infiltrates of CD68+Macrophages and Neutrophils Predict Anastomotic Leakage
D. Schöb, T. Schuler, C. Klink, K. Junge, D. Busch, P. Neumann, M. Binnebösel
Chair(s): Jiri Fronek, Ignacio Garcia Alonso & Olivér Rosero
10:40 - 10:50h
at Pest Room (C)
Categories: Gastrointestinal Surgery, Oral Session
Session: Oral Session XI - Gastrointestinal Surgery I
Background
Anastomotic leakage in elective laparoscopic sigmoid resection due to diverticulitis is a complication with a remarkable morbidity and mortality. The aim of this study was to evaluate the predictive value of a potential pre-existing low grade inflammation regarding the incidence of anastomotic leakage.
Material and Methods
Patients with either chronically recurrent diverticulitis or sigmoid stenosis caused by chronic diverticulitis were included in this study. Patients underwent laparoscopic sigmoid resection with end-to-end stapler anastomosis. For immunohistochemical evaluation the anastomotic tissue acquired rings were preserved and further processed. As markers of cellular immune response CD68+ macrophages, neutrophils, CD3+ T-lymphocytes, and CD11c+ dendritic cells as well as other key receptors of inlammatory response were evaluated within the acquired sample of colonic bowel wall tissue. Clinical and immunohistochemical data was compared between groups (leakage vs. no leakage).
Result
83 patients were included in this study. Seven patients suffered an anastomotic leakage, one of which required reoperation.The remaining six patients were treated conservatively. The matched-pair analysis revealed a significantly higher percentage of CD68+ macrophages and
neutrophils in the colonic wall obtained at the index operation in both the mucosal and submucosal layer for the leakage group.
Conclusion
A pre-existing low grade inflammation represented by infiltrates of macrophages and neutrophils is a predictor for increased risk of developing colon anastomotic leakage. In further studies the importance of those inflammatory cells has to be illuminated on a molecular level in order to develop potential and specific therapeutic approaches to avoid an aberrant intestinal wound
healing
